New psychiatric diagnoses developed in secret

The LA Times has an op-ed piece on the current arguments over whether the new version of the DSM, the influential diagnostic manual of mental illness, should be developed transparently or whether decisions should continue to be made in secret as is currently the case.

The DSM-V is due out in May 2012, and all mental illness and proposals for the classifications of new mental illness are currently under review by the DSM-V committee.

While the manual tends only to be used clinically in North and South America (Europe uses the World Health Organisation’s ICD-10 manual), it has a far greater reach because psychiatric research all over the world has a tendency to use DSM diagnoses for consistency.

However, it will have a particularly strong impact in the United States, owing to the health insurance-based health care system that tends only to recognise ‘official’ diagnoses as worthy of funding.

Needless to say, both the pharmaceutical industry and pressure groups have a vested interest in getting specific disorders recognised and there is apparently a great pressure on the committees to include certain concepts.

One of the psychiatrists (former editor Robert Spitzer) wanted transparency; several others, including the president of the American Psychiatric Assn. and the man charged with overseeing the revisions (Darrel Regier), held out for secrecy. Hanging in the balance is whether, four years from now, a set of questionable behaviors with names such as “Apathy Disorder,” “Parental Alienation Syndrome,” “Premenstrual Dysphoric Disorder,” “Compulsive Buying Disorder,” “Internet Addiction” and “Relational Disorder” will be considered full-fledged psychiatric illnesses.

Spitzer, a key figure in the development of the current diagnostic system, is pushing for transparency so everyone can see the minutes and correspondence to keep an eye on the potential pressures brought to bear on the members.

Indeed, one of the criticisms of the past committees has been that large numbers of the central decision-makers have had financial ties to the drug industry, a trend which is apparently not much different for the DSM-V committee.

There’s also a good commentary over at Furious Seasons if you’re interested in some more background to the controversy.